Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
Cardiovasc Revasc Med. 2022 Sep;42:55-61. doi: 10.1016/j.carrev.2022.02.023. Epub 2022 Feb 26.
First-phase left ventricular ejection fraction (LVEF1) is an early marker of left ventricular remodeling. Reduced LVEF1 has been associated with adverse prognosis in patients with aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF). It remains to be determined, whether reduced LVEF1 differentiates clinical outcomes after aortic valve replacement.
We investigated the impact of LVEF1 on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe AS with preserved LVEF (≥ 50%).
In the prospective Bern TAVI registry, we retrospectively categorized patients according to LVEF1 as assessed by transthoracic echocardiography. Clinical outcomes of interest were all-cause mortality and residual heart failure symptoms (New York Heart Association (NYHA) functional class III or IV) at 1 year after TAVI.
A total of 644 patients undergoing TAVI between January 2014 and December 2019 were included in the present analysis. Patients with low LVEF1 had a lower LVEF (62.0 ± 6.89% vs. 64.3 ± 7.82%, P < 0.001) and a higher left ventricular mass index (129.3 ± 39.1 g/m vs. 121.5 ± 38.0 g/m; P = 0.027) compared to patients with high LVEF1. At 1 year, the incidence of all-cause/cardiovascular death, and NYHA III or IV were comparable between patients with low and high LVEF1 (8.3% vs. 9.2%; P = 0.773, 3.9% vs. 6.0%; P = 0.276, 12.9% vs. 12.2%; P = 0.892, respectively).
Reduced LVEF1 was not associated with adverse clinical outcomes following TAVI in patients with symptomatic severe AS with preserved LVEF.
gov. NCT01368250.
第一时相左心室射血分数（LVEF1）是左心室重构的早期标志物。在主动脉瓣狭窄（AS）和保留的左心室射血分数（LVEF）患者中，LVEF1 降低与不良预后相关。然而，LVEF1 是否能区分经导管主动脉瓣置换术（TAVI）后主动脉瓣置换术的临床结果仍有待确定。
我们研究了 LVEF1 在经胸超声心动图评估的有症状严重 AS 合并保留的 LVEF（≥50%）患者接受 TAVI 后对临床结果的影响。
在前瞻性的 Bern TAVI 注册研究中，我们根据 LVEF1 将患者分为不同组别。感兴趣的临床结果是 TAVI 后 1 年的全因死亡率和残余心力衰竭症状（纽约心脏协会（NYHA）心功能 III 或 IV 级）。
共纳入 2014 年 1 月至 2019 年 12 月期间接受 TAVI 的 644 例患者。LVEF1 较低的患者的 LVEF 较低（62.0±6.89%比 64.3±7.82%，P＜0.001），左心室质量指数较高（129.3±39.1 g/m2 比 121.5±38.0 g/m2；P=0.027）。与 LVEF1 较高的患者相比，LVEF1 较低的患者在 1 年时全因/心血管死亡率和 NYHA III 或 IV 发生率相似（8.3%比 9.2%；P=0.773，3.9%比 6.0%；P=0.276，12.9%比 12.2%；P=0.892）。
在有症状的严重 AS 合并保留的 LVEF 的患者中，TAVI 后 LVEF1 降低与不良临床结果无关。
https://www.clinicaltrials.gov。
NCT01368250。
